Medicine’s Big New Battleground: Does Mental Illness Really Exist?

First NIMH, now DCP… Looks like a world war between psychologists and psychiatrists may be brewing. Jamie Doward writes in the Guardian:

It has the distinctly uncatchy, abbreviated title DSM-5, and is known to no one outside the world of mental health.

But, even before its publication a week on Wednesday, the fifth edition of the Diagnostic and Statistical Manual, psychiatry’s dictionary of disorders, has triggered a bitter row that stretches across the Atlantic and has fuelled a profound debate about how modern society should treat mental disturbance.

Critics claim that the American Psychiatric Association’s increasingly voluminous manual will see millions of people unnecessarily categorised as having psychiatric disorders. For example, shyness in children, temper tantrums and depression following the death of a loved one could become medical problems, treatable with drugs. So could internet addiction.

Inevitably such claims have given ammunition to psychiatry’s critics, who believe that many of the conditions are simply inventions dreamed up for the benefit of pharmaceutical giants.

A disturbing picture emerges of mutual vested interests, of a psychiatric industry in cahoots with big pharma. As the writer, Jon Ronson, only half-joked in a recent TED talk: “Is it possible that the psychiatric profession has a strong desire to label things that are essential human behaviour as a disorder?”

Psychiatry’s supporters retort that such suggestions are clumsy, misguided and unhelpful, and complain that the much-hyped publication of the manual has become an excuse to reheat tired arguments to attack their profession.

But even psychiatry’s defenders acknowledge that the manual has its problems. Allen Frances, a professor of psychiatry and the chair of the DSM-4 committee, used his blog to attack the production of the new manual as “secretive, closed and sloppy”, and claimed that it “includes new diagnoses and reductions in thresholds for old ones that expand the already stretched boundaries of psychiatry and threaten to turn diagnostic inflation into hyperinflation”.

Others in the mental health field have gone even further in their criticism. Thomas R Insel, director of the National Institute of Mental Health, the American government’s leading agency on mental illness research and prevention, recently attacked the manual’s “validity”.

And now, in a significant new attack, the very nature of disorders identified by psychiatry has been thrown into question. In an unprecedented move for a professional body, the Division of Clinical Psychology (DCP), which represents more than 10,000 practitioners and is part of the distinguished British Psychological Society, will tomorrow publish a statement calling for the abandonment of psychiatric diagnosis and the development of alternatives which do not use the language of “illness” or “disorder”.

The statement claims: “Psychiatric diagnosis is often presented as an objective statement of fact, but is, in essence, a clinical judgment based on observation and interpretation of behaviour and self-report, and thus subject to variation and bias.”

The language may be arcane, but the implication is clear. According to the DCP, “diagnoses such as schizophrenia, bipolar disorder, personality disorder, attention deficit hyperactivity disorder, conduct disorders and so on” are of “limited reliability and questionable validity”.

Factuality becomes almost besides the point when an innovation becomes so deeply ingrained in the public imagination. Perception is reality.

Besides which, when unstoppable force collides with immoveable object something has to give. Since the concept of God died, we’ve had to patch the hole with something. With what would you propose we replace it? Tolerance?

Thanks but no thanks.

Simon Valentine

maybe we’ll go philosophy again
an unstoppable force meets two immovable objects
which one is it vs.?
tolerance as a non specific abstract mathematical engineering application term isn’t tolerance, but that’s like saying English isn’t legitimate.

it’s not wrong to say, it’s just that it’s redundant.

jnana

the concept of god is far from dead. faith is a constant source of comfort for lots of people. perhaps they are people you don’t identify with. but that is only caused by yer lack of empathy.

DeepCough

Mental illness is a side effect of civilization.

Andrew

You might have that backwards.

Calypso_1

That considerably brightened my mood.

DeepCough

Nope, that’s on the money.

http://hormeticminds.blogspot.com/ Chaorder Gradient

I wonder how much the diagnosable people correlate with the belief that mental illness doesn’t exists. Barring physiological illnesses, how many mental illnesses are merely caused by particularly strongly held beliefs. Kinda wanna hear Calypso’s take on this

Gordon

I for one, was diagnosed as having Type II Bipolar Disorder in college by a University Psychiatrist, when it turns that I was in fact, actually just “sad”. I declined the medication and am now perfectly healthy and happy, with no pharmaceuticals whatsoever.

The diagnosis seemed to be so automatic and confidently the response to my problem that I’m sure there were 1000’s of others in my community with the same incorrect view of the real problem.

http://hormeticminds.blogspot.com/ Chaorder Gradient

I ask these kinds of things because I once dated someone who unbeknownst to me was diagnosed with bipolar disorder. Unlike you though, she was diagnosed and prescribed Lithium…. around the age of 14.

She was genuinely unstable by the time i knew her, and burdensome to those surrounding her, but I truly wonder what kind of person she would have been unmedicated.

I hesitate to say the most extreme cases are all medicinally induced, but the most irrational cases I have come in contact with were medicated. I know the argument against this sentiment is usually “well just imagine them if they -Weren’t- medicated” but that’s a non-existent sample of people. Once they are medicated… its a hypothetical that cannot be answered, so whatever bias one has is the answer that is accepted.

http://hormeticminds.blogspot.com/ Chaorder Gradient

“… subject to variation and bias.”

Of course we can always consider that while it will never be a science, that isn’t necessarily a bad thing. People seem to have forgotten that there are reasonable conclusions that can be made that are not under the umbrella of science. But of course, who want’s to deal with a messy reality where that’s true?

the use of and now the disuse of the DSM
is all about increasing patient treatment volumes
and drug prescriptions
to take the discussion beyond the boundaries of business & economics
is to be completely misled

jnana

mental illness, as it is defined today, is largely a social construct.
but I can still say, as I define it, there is probably not a single human(or perhaps not even a single entity) who is not mentally ILL. We are all in need of the grace that can heal.

JoiquimCouteau

We have not lost faith,
but we have transferred it from God
to the medical profession.

In evaluating dysfunction or illness, we have long followed the seemingly straightforward model of diagnose, treat, evaluate, iterate. However, diagnosis has long been the secret -- or not so secret --...